The Importance of Order and Complements: A New Way to Understand the Dutch and German Health Insurance Reforms

Helderman, Jan-Kees; Stiller, Sabina

doi:10.1215/03616878-2743051

Cited by 8 publications

(6 citation statements)

References 23 publications

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“…Concerning coverage, consider the Netherlands prior to 2006. The statutory health insurance system for regular curative medical care (there was a separate social insurance system for “exceptional” or long term care that covered 100% of the population) only covered about 63% of all citizens [ 5 ]. Those whose income was (or grew to be) above the ceiling threshold (32,500 Euros in 2004) were required by law to leave the statutory system This meant, on the one hand, that these higher-income individuals were required to seek private commercial health insurance, which set its premiums based on individual experience (eg personal health-status and family history) rather than community experience (eg collective) costs.…”

Section: Introductionmentioning

confidence: 99%

Health sector solidarity: a core European value but with broadly varying content

Saltman

2015

Isr J Health Policy Res

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Although the concept of solidarity sits at the center of many European health sector debates, the specific groups eligible for coverage, the financing arrangements, and the range of services and benefits that, together, compose the operational content of solidarity have all changed considerably over time. In prior economic periods, solidarity covered considerably fewer services or groups of the population than it does today. As economic and political circumstances changed, the content of solidarity changed with them. Recent examples of these shifts are illustrated through a discussion of health reforms in Netherlands, Germany and also Israel (although not in Europe, the Israeli health system is similar in structure to European social health insurance systems).This article suggests that changed economic circumstances in Europe since the onset of the 2008 financial crisis may lead to re-configuring the scope and content of services covered by solidarity in many European health systems. A key issue for policymakers will be protecting vulnerable populations as this re-design occurs.

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Section: Introductionmentioning

confidence: 99%

Health sector solidarity: a core European value but with broadly varying content

Saltman

2015

Isr J Health Policy Res

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“…This "overwriting" metaphor is similar in many respects to the metaphor of "layering" which is widely used in institutionalist literature (Mahoney and Thelen, 2010;Helderman and Stiller, 2014). Both metaphors emphasise the incompleteness and patchy nature of institutional change.…”

Section: Introductionmentioning

confidence: 90%

Overwriting New Public Management with New Public Governance in New Zealand's approach to health system improvement

Tenbensel

Silwal

Walton

2021

JHOM

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PurposeIn 2016, New Zealand's Ministry of Health introduced the System Level Measures Framework which marked a departure from health targets and pay-for-performance incentives towards an approach based on local, collaborative approaches to health system improvement. This exemplifies an attempt to “overwrite” New Public Management (NPM) institutional practices with New Public Governance (NPG). We aim to trace this process of overwriting so as to understand how attempts to change institutional practices were facilitated, blocked, translated and edited.Design/methodology/approachWe develop a conceptual framework for understanding and tracing institutional change towards NPG which emphasises the importance of discursive strategies in policy attempts to overwrite NPM with NPG. To analyse the New Zealand case, we drew on policy documents and interviews conducted in 2017–18 with twelve national key informants and fifty interviewees closely involved in local development and/or implementation of the SLMF.FindingsPolicy sponsors of collaborative approaches to health system improvement first attempted formal institutional change, arguing that adopting collaborative, quality improvement (NPG) approaches would supplement existing performance management (NPM) practices, to create a superior synthesis. When this formal approach was blocked, they adopted an approach based on informal persuasion of local organisational actors that quality improvement should supplant performance improvement. This approach was edited and translated by local actors, and the success of local implementation varied considerably.Research limitations/implicationsThis article offers a novel conceptualisation of public management institutional change, which can help explain why it is difficult to completely erase NPM practices in health.Originality/valueThis paper explores the rhetorical practices that are used in the introduction of a New Public Governance policy framework.

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“…Over the past decades, the Dutch healthcare system has gradually changed from 'social service to a commercial industry' (Wachter 2017, 24). According to different scholars, especially since 1986, the sector has turned 'merchandise' 1 (Rutgers 2018, 11; see also Maarse 2011;Maarse, Jeurissen, and Ruwaard 2016;Tuohy 2018) and is now characterised as 'managed competition' (Groenewegen 1994;Hassenteufel et al 2010;Helderman and Stiller 2014;Hester van de Bovenkamp, Annemiek Stoopendaal, and Ronald Bal 2017;Bertens and Vonk 2020). The changes stemmed from a growing concern among Dutch policymakers and medical experts about the increasing percentage of gross domestic product that was being spent on public healthcare.…”

Section: Context: Public Healthcare In the Netherlandsmentioning

confidence: 99%

The Medical Tech Facilitator: An Emerging Position in Dutch Public Healthcare and Their Tinkering Practices

Van Voorst

2024

MAT

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This article focuses on the emerging position of the ‘medical tech facilitator’ developed by practitioners in the Dutch public healthcare system. The analysis is based on anthropological fieldwork conducted in Dutch hospitals. It highlights, firstly, the practices and ongoing negotiations that these facilitators engage in, to maintain a position between two parties—the medical sector and the technology industry. I argue that the practices of medical tech facilitators are not (only) a result of personal, lucrative interests, but should be seen as a pragmatic way of coping, or tinkering, with a healthcare system that is experienced by them as frustrating and inefficient. Secondly, the article reveals the outcomes of these practices for public healthcare. I will pose that this emerging and ambiguous position leads to a co-production of specific health policies—something which is concerning, considering the fact that medical tech facilitators typically lack technological expertise. As such, they both resist and reproduce the problems they experience in their daily work.

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The Importance of Order and Complements: A New Way to Understand the Dutch and German Health Insurance Reforms

Cited by 8 publications

References 23 publications

Health sector solidarity: a core European value but with broadly varying content

Health sector solidarity: a core European value but with broadly varying content

Overwriting New Public Management with New Public Governance in New Zealand's approach to health system improvement

The Medical Tech Facilitator: An Emerging Position in Dutch Public Healthcare and Their Tinkering Practices

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